Disorders of sex development(DSD) include anomalies of sex chromosomes,gonads,reproductive ducts,and genitalia.Here,the term "intersex" is avoided because of its imprecision.The purpose of this review is to assist health care professionals in the provision of treatment,education,and support to children born with DSD and to their families.The goal of DSD treatment is to achieve the long-term physical,psychological,and sexual well-being of the patients.In the case of DSD it involves several principles.Providing medical and surgical care to deal with a complication that threatens to the patient's physical well-being;minimizing the potential for the patient and family to feel ashamed,stigmatized,or overly obsessed with genital appearance;delaying elective surgical and hormonal treatments until the patient can actively participate in decision-making;telling the truth to the family and the child and addressing psychosocial distress of the children and their parents.This approach is termed as "patient-centered".

Objective This study was designed to evaluate the effect of laparoscopic-assisted subtotal colectomy(LASC)and modified Duhamel procedure in the treatment of severe functional constipation(SFC).Methods From June 2005 to October 2007,100 cases of SFC were treated by LASC combined with modified Duhamel procedure in our institute.After freed the colon under a laparoscope,we made a small incision in the lower abdomen to perform subtotal colectomy while preserved the ileocecal region.Then a side-to-side colorectal anastomosis was conducted.Results In this study,98 cases of LASC were successively completed and 2 cases were converted to open surgery.The operation time of LASC in the 98 cases ranged from 48 to 125 min mean,(76?23)min],and the total operation time was 140-225 min mean,(170?42)min].The intraoperative blood loss was 10-160 m1 mean,(35?18)m1].In the patients,the intestinal function was recovered within 25-52 hours mean,(42?12)h] after the operation;none of them developed postoperative wound infection,anastomotic stoma,or other complications.One week after the operation,2 of the 100 patients showed mild dehydration,and 2 were diagnosed as having incomplete small bowl obstruction.All of the four were cured by conservative treatments.The other 96 patients who had no complication were discharged from the hospital in 5-11 days mean,(7.0?1.5)days] postperation.One year later,the symptoms of constipation were significantly alleviated(defecation 1-3 times/d)in 90 patients;7 cases had various degrees of diarrhea(defecation 4-6 times/d);and 3 patients showed recurrence of mild constipation(defecation 1 time/2-3 d).The gastrointestinal quality of life index(GIQOL)determined in 1 year postperation was(109?20)points,which indicated good results compared to(94?23)points before the operation(maximum:144).Eighty-three cases were satisfied with their frequency of defecation.Conclusions LASC combined with modified Duhamel procedure is an effective method for the treatment of SFC,resulting in less damage,less influence to the internal environment,and quick recovery.The procedure is worth being wildly used.

Objective:According to the existing hospital static mixing method, the problem of dynamic allocation model for half a year period is put forward, in order to solve emergency equipment safe are deployed in a timely manner. Methods: The hospital can allocate all emergency equipment evaluation, grade and tabulation, according to the score for sorting, system of sorting table provides emergency center allocate use half a year. Results: According to the deployment of table realized in emergency equipment safety in time in case of major events are deployed and able to skillfully use effect. Conclusion: The use of emergency equipment dynamic allocation model can not only improve the social benefit of the hospital, and reduce the pressure of the functions of the hospital departments.

BACKGROUND:Because of osteoporosis, short-segment transpedicular fixation or screw-rod system fixation is prone to screw loosening depending on its poor anti-pul-out strength in patients with thoracolumbar fracture with ankylosing spondylitis.
OBJECTIVE:To probe the clinic outcomes of multi-segment transpedicle spinal fixation for thoracolumbar fractures with ankylosing spondylitis.
METHODS:Eleven patients with ankylosing spondylitis combined with thoracolumbar fracture in the Fourth Department of Orthopedics, Meizhou Hospital, Sun Yat-sen University, China from January 2009 to December 2012 were selected. Al the patients underwent posterior reduction and multi-segment transpedicle spinal fixation, among whom, six cases were subjected to internal fixation through the pedicle of fractured vertebra.
RESULTS AND CONCLUSION:Al of the 11 patients were fol owed up for 13 to 36 months. Solid bone healing was achieved in al of the patients, and there were no complications related to the internal fixation systems such as loosening or breakage. Three cases of spinal cord injury achieved Frankel’s class E from class C recovery. Lumbodorsal pain rate achieved 100%according to the Japanese Orthopaedic Association scoring. Results confirmed that it is effective to treat thoracolumbar fractures with ankylosing spondylitis by posterior reduction and multi-segment transpedicle spinal fixation. Strong internal fixation and fracture union can be achieved by operation.

ObjectiveTo investigate the inhibitory effects of indomethacin(IN) on proliferation and DNA synthesis of cultured human fetal retinal pigment epithelium(hRPE) cells in vitro.MethodsPrimary culture and subculture of hRPE cells were established in vitro first.Cultured hRPE cells were treated by various concentrations 50,100,200,400,600 μ mol/L(final concentration)of IN for 24h.After 24h,the amount of DNA in RPE cells was determined by the absorbance at 280nm of Nucleic Acid δ Protein Analysis.Cells proliferation of RPE were measured with methyl thiazolyl tetrazolium(MTT) assay method by adding 100,200,400,600,800,1000μ mol/L(final concentration) of IN for 12h.ResultsAfter added various concentrations of IN,the DNA concentrations were ( 101.1712± 15.5124),( 88.6400± 13.5845),( 72.3651± 7.7969),( 59.9089± 10.7229),( 51.2236± 8.7757)μg/ml respectively,P values were 0.000,0.000,0.000,0.000,0.000(q test) as compared to that ( 213.7351± 83.1572)μg/ml in 0μg/L IN.The A values added 100,200,400,600,800,1000μmol/L of IN were ( 0.2367± 0.0546),( 0.1687± 0.0695),( 0.0819± 0.03461),( 0.0656± 0.01759),( 0.0554± 0.02865),( 0.0508± 0.02775)respectively,P values were 0 .158,0.000,0.000,0.000,0.000,0.000(q test) as compared to ( 0.2674± 0. 04302) of A value of 0ug/L IN.ConclusionThe data suggested that IN can inhibit DNA synthesis and proliferation of hRPE cells in vitro in a dose dependent manner.

The battlefield rescuing unit of the current model is always restricted by some factors such as regional environments in wartime rescuing action and peacetime disaster relief, which can lead to failure of following and deploying action, so that wounded persons can not be rescued at the first time. Aiming at the special circumstances, a forward first-aid unit composed of five doctors and nurses should be established to give emergency medical rescue with rescuing emergent equipments and medicine packed in portable packages such as portable respiring machine, defibrillator and oxygen device at the battlefront. In this way, success rate of rescuing wounded persons would be increased obviously, while mortality rate and deformity rate would be decreased greatly.

Objective To summerize the clinical experience of 23 cases of carotid cavernous fistula(CCF) and discuss the treatment strategy. Methods Retrospectively analyzed 23 patients(11 males and 12 females) of CCF,including 14 patients with Barrow type A,1 with type B,1 with type C and 7 with type D. Results Vascular approach for embolization was undertaken in 20 cases by transarterial access and 2 via venous route while 1 case was given up. Among them,9 cases obtained complete occlusion by simple balloon embolization and 5 were treated by direct occlusion of internal carotid artery. Another 5 cases used NBCA glue for the occlusion,1 case was embolized by gelatin-sponge particulates combined with compression of carotid artery,2 cases were treated by coil embolization of cavernous sinus and 1 case was only managed by carotid compression maneuver. We achieved satisfactory clinical results with 21 patients cured and 2 patients improved. Conclusion Complexity and refractory are the characteristic of CCF,and endovascular treatment should be the major choice of treatment. (J Intervent Radiol,2006,15: 323-326)

Objectives By Oxford pathological classification and analysis of circulating complement complement 3 (C3),renal C3 deposition,and clinical laboratory tests,we discussed the correlation between complement C3 and immunoglobin A nephropathy (IgAN) in pathogenesis.Methods A retrospective study of 558 IgAN cases at Xinhua Hospital from January of 2000 through December of 2013 was performed.All 558 IgAN diagnoses were made and confirmed by renal needle biopsy.Results Compared to patients who had circulating C3 ＜ 0.9,patients with circulating C3 level ＞ 0.9 showed statistically significant decreases in serum creatinine [(100.92 ± 105.31) μmol/L vs (157.58 ± 208.39) μmol/L,t =-2.283,P =0.025],blood urea nitrogen [(5.69 ± 2.88) mmol/L vs (7.69 ± 5.90) mmoL/L,t =-2.81,P =0.006];besides,other parameters like IgA,body weight,body mass index (BMI),cholesterol,triglyceride,serum IgA/C3 ratio,albumin,and estimated glomeruli filtrate rate (eGFR) also presented statistically significant differences between two patient groups;no statistically significant differences were observed between two groups in glomerular mesangial cell proliferation,capillary endothelial proliferation,segmental glomerular sclerosis or adhesions,renal tubule atrophy,tubulointerstitial fibrosis,and formation of glomerular crescent;meanwhile,no statistically significant differences were observed between two groups in mesangial depositions of IgA,IgG,IgM,and complement C3;meanwhile the blood level of C3 between C3 deposition negative group,deposition 2 + and 3 + subgroup showed statistically significant differences (2.493 and 2.782;0.013 and 0.006),nevertheless,prognostic indices in Oxford classification,such as mesangial cell proliferation,capillary endothelial proliferation,segmental glomerular sclerosis or adhesions,renal tubule atrophy and tubulointerstitial fibrosis,were also statistically different between two patient groups (Pearson Square test result was 50.782,35.141,21.105,30.182,respectively;P ＜0.01).Conclusions Renal deposition of complement C3 or decrease in circulating C3 level may be associated with a poor prognosis of IgA nephropathy,and alteration in C3 dynamics may be implicated in the pathogenesis of IgAN through its involvement in humoral immunity.

Objective:To investigate the onset mechanism of cervical vertigo from the proprioceptive sensation and provide clinical basis for its treatment.Methods:Among the 121 cases that conformed to the diagnostic criteria of cervical vertigo,70 cases who presented with negative neck-rotation test and cervical vertigo without obvious vascular factors by transcranial Doppler(TCD)were assigned to the observation group,while 51 cases who presented with positive neck-rotation test and cervical vertigo due to spasm of vertebral basal artery or insufficient blood supply by TCD were assigned to the control group.The cases in the two groups were treated once every day,5 days make up one treatment course and the resuIts were statistically analyrzed after one treatment course.Results:The skull triaxial spatial offset of the cases in the two groups were significantly reduced after the treatment (P<＜0.01).However, there was no statistically significant difference between the skull triaxial spatial offset between the two groups (p＞0.05).It is not conclusive that the therapeutic effect in the two groups was significantly different after one treatment course.Conclusion:Tuina manipulation therapy can improve the skull spatial ofrset repositioning ability of the Patients.